Clinical Factors Useful For The Differentiation Of Acute Arterial Embolism From Acute Arterial Thrombosis Of The Lower Extremities And Factors Affecting Its Clinical Categories

Objective: To assess the clinical factors significant for the differentiation betweenacute arterial embolism and acute arterial thrombosis in acute lower extremityischemia and explore the related factors concerning the clinical categories of acutelimb ischemia.Methods：A retrospective study of the124patients with acute limb ischemia(ALI)was carried out from May2005to December2011. Depengding on the digitalsubtraction angiography(DSA) findings, the patients were divided into acute arterialembolism group and acute arterial thrombosis group at last. All clinical informationsdata were analyzed and compared between the two groups, including: sex, age,ischemic time, the obstructed sites, clinical manifestations、 histories(history ofsmoking vs pervious history of acute limb arterial embolism), other comorbidities（Atrial fibrillation, coronary heart disease，rheumatic heart disease，Ischemic heartdisease，Stroke，diabetes mellitus, hypertension，Hypercholesterol，Renal failure）.Some of the above, which might influence the clinical categories of acute limbischemia, were performed with multivariate logistic regression analysis.The data wereexamined using SPSS11.5software.Results：Among124patients,82cases fulfilled the criteria of acute arterial embolism（59cases,71.9%）and acute arterial thrombosis（23cases,28.1%）. The arterialocclusion was more commonly observed at iliac and femoral artery in patients withacute arterial embolism(χ2=4.057，P＜0.05), while multi-site of arterial stenosis wasonly existed in patients with acute arterial thrombosis(P=0.001). Patients with acutearterial embolism presented more severe clinical manifestations such as paresthesia(χ2=5.121, P＜0.05) and paralysis(χ2=9.146, P＜0.05). Normal peripheral pulse onthe contralateral limb was more common than in patients with acute arterial thrombosis (χ~2=15.655, P＜0.05). On the contrary, the previous symptom ofintermittent claudication (χ~2=8.567, P＜0.05) was more often observed in patientswith acute arterial thrombosis than in patients with acute arterial embolism. Theseverity of ischemia in patients with acute arterial embolism tented to becomeimmediately threatened Ⅱb grade(χ~2=4.774, P＜0.05),while marginally threatenedischemia was more often observed in patients with acute arterial thrombosi（sχ~2=6.133,P＜0.05）.Diabetes mellitus (χ~2=18.622, P＜0.05), hypertension（χ~2=9.857, P＜0.05）and smoking habit（χ~2=5.417, P＜0.05）were detected more in patients with acutearterial thrombosis than acute arterial embolism while Atrial fibrillation was adversed(χ~2=6.133, P＜0.05). Previous arterial embolism(χ~2=3.973, P＜0.05)were onlydetected in patients with acute arterial embolism. The statistically significantinfluencing factors of the clinical categories of acute limb ischemia include ischemictime, diabetes mellitus,cause of the occlusion(P<0.05).Conclusion：The clinical factors significant for the differentiation between acutearterial embolism and acute arterial thrombosis included clinical manifestations（impaired sensation, aralysis and peripheral pulse condition of the healthy limb）,the obstructed sites, the history of intermittent claudication and the previous arterialembolism, progression of ischemic status and the high-risk factors of the peripheralvascular disease（atrial fibrillation, diabetes mellitus, hypertension and smokinghabit）. The clinical categories of acute limb ischemia could be influenced byischemic time, diabetes mellitus,cause of the occlusion.